HEART DISEASE. Six actions the next Australian Government must take to tackle our biggest killer: National Heart Foundation of Australia 2016

Transcription

1 Six actions the next Australian Government must take to tackle our biggest killer: HEART DISEASE National Heart Foundation of Australia 2016 NATIONAL HEART FOUNDATION OF AUSTRALIA 1

2 Contents The challenge 2 The facts 3 Our policy proposals align with national health objectives 3 Six actions to tackle cardiovascular disease 4 Develop a heart and stroke strategy 6 Detect and manage those at risk 7 Fund 50 cardiovascular disease research fellowships 8 Help Australians Move more, sit less 9 Close the gap on rheumatic heart disease 10 Fund a national audit of cardiac rehabilitation services 11 A comprehensive approach to cardiovascular disease 12 References 13 The challenge The Australian Institute of Health and Welfare (AIHW) has rightly identified chronic disease as Australia s biggest health challenge. But to successfully meet the chronic disease challenge, Australia must do more to tackle one of its largest, and most costly, components: cardiovascular disease (heart, stroke and blood vessel disease). By itself, coronary heart disease is the single biggest killer of Australians, claiming 20,173 lives, or 13.1% of all deaths registered in Cardiovascular disease is a major cause of premature death. This policy paper identifies six cost-effective actions that the next Australian Government must take in order to: help all Australians lead longer, healthier lives boost productivity improve the efficiency and effectiveness of our healthcare system help prevent not only cardiovascular disease, but many other chronic conditions, including some cancers, type 2 diabetes, kidney disease and dementia. SIX ACTIONS TO TACKLE CARDIOVASCULAR DISEASE 2

3 The facts Cardiovascular disease (heart, stroke and blood vessel disease) is: the most costly disease group ($7.7 billion a year, or 10.4% of direct healthcare expenditure, including $4.5 billion on hospital admissions and $1.65 billion on pharmaceuticals) 2 highly prevalent, with 4.2 million Australians living with some form of cardiovascular disease 3 a major cause of avoidable hospital admissions 4 the cause of almost one-third of all deaths (30%) 5 responsible for 23% of fatal burden of disease (Years of Life Lost, YLL) 6 largely preventable. Our policy proposals align with national health objectives Intergenerational Report The 2015 report identifies changing patterns of chronic disease as a key health cost driver, acknowledges the importance of prevention and improved cardiac care as a factor in increased life expectancy, and identifies the need for Australians to stay active as they age. Council of Australian Governments A new focus on primary care and keeping people out of hospital is necessary. When it comes to chronic care, the issues of diabetes, heart disease and mental health require particular attention. Leader s Retreat communique, July 2015 Close the Gap The implementation plan has a strong focus on prevention, as well as on improving the patient journey of Aboriginal and Torres Strait Islander peoples through the health system. Australian Institute of Health and Welfare With an ageing population and more prevalent risk factors, the AIHW identifies chronic disease as Australia s biggest health challenge. Chronic disease is often discussed in terms of four major disease groups cardiovascular diseases, cancers, chronic obstructive pulmonary disease and diabetes with four common behavioural risk factors: smoking, physical inactivity, poor nutrition and harmful use of alcohol. Within these groups, cancer and cardiovascular disease account for more than half of Australia s disease deaths. NATIONAL HEART FOUNDATION OF AUSTRALIA 3

4 Six actions to tackle cardiovascular disease SIX ACTIONS TO TACKLE CARDIOVASCULAR DISEASE 4

5 Six actions to tackle cardiovascular disease 1. Develop a national heart and stroke strategy Address a glaring gap in the current Federal health approach to chronic disease by developing a heart disease strategy to sit under the National Strategic Framework for Chronic Conditions. $0.5 million 2. Detect and manage those at risk Prevent avoidable hospital admissions through early detection of those at risk of heart attack, stroke, diabetes, kidney disease and other vascular conditions by increasing uptake of the Integrated Health Check. No cost for new quality incentive program. Fund new MBS item 3. Fund 50 cardiovascular disease research fellowships Fund 50 cardiovascular research fellowships and ensure the new Medical Research Future Fund invests in research that focuses on the major causes of the Australian disease burden. $24 million over 3 years 4. Help Australians Move more, sit less Fund the development of a national physical activity action plan to help tackle chronic disease by educating and enabling Australians to be active in their everyday lives. Scalable from $35 million a year 5. Close the gap on rheumatic heart disease Continue to fund the National Partnership Agreement on rheumatic fever strategy and Rheumatic Heart Disease Australia (RHDAustralia). $10 million over 3 years 6. Fund a national audit of cardiac rehabilitation services Improve chronically low levels of participation in life saving cardiac rehabilitation programs through an annual audit. $1 million a year NATIONAL HEART FOUNDATION OF AUSTRALIA 5

6 There is strong support across jurisdictional and non-government stakeholders for the formulation of a national action plan for cardiovascular disease Develop a national heart and stroke strategy Recommended action: Develop a comprehensive national strategy for heart disease and stroke as an integral part of the National Strategic Framework for Chronic Conditions. Although cardiovascular disease remains a leading killer of Australians and is the most costly disease in terms of direct healthcare costs, there is no national action plan to promote measures that will ease the burden this disease group imposes on our community. This is a glaring omission, particularly as there are major gaps in the current approach to cardiovascular disease prevention, early detection, management and research. There is now an ideal opportunity to develop a national heart and stroke action plan as all Australian governments have agreed to develop a new National Strategic Framework for Chronic Conditions. Work is well underway to develop the new framework, which will replace the ageing National Chronic Disease Strategy. While the framework will inevitably be a high-level document, it will sit above a range of important strategies and action plans that will cover specific disease groups and risk factors. The development of an Australian heart and stroke strategy must be part of the new approach to chronic disease. A well-constructed national heart and stroke action plan can achieve these objectives and sit alongside other disease-specific strategies that have been developed, including the recently announced National Diabetes Strategy. The case for a national heart and stroke action plan is clear. While mortality rates have been in decline for several decades, cardiovascular disease still causes almost 30% of all deaths, is a leading cause of the total burden of disease in Australia (15% of the total burden) and imposes massive social and economic costs comprising 10.4% of total direct healthcare expenditure. 6 A national heart and stroke action plan has already been supported by the Australian Government s Review of Cardiovascular Disease Programs (Birch Review). Disturbingly, the number of people with cardiovascular disease is set to increase as the population grows, ages and becomes increasingly overweight and obese, and some risk factors, such as poor nutrition, lack of physical activity, high blood cholesterol and high blood pressure, continue at alarmingly high rates. Much more can be done and done in a highly costeffective way to prevent premature death, improve quality of life and reduce the immense economic burden cardiovascular disease places on the health system. SIX ACTIONS TO TACKLE CARDIOVASCULAR DISEASE 6

7 Combining a risk assessment for heart disease and stroke, a type 2 diabetes check and a kidney disease test into an integrated health check is considered best practice as it consolidates the necessary checks a patient can request from their doctor. 2. Detect and manage those at risk Recommended action: Include the Integrated Health Check and on-going management of patients at risk as part of the development of a new, quality-focussed Practice Incentive Program (PIP). Provide a Medicare Benefits Schedule (MBS) item to support uptake of the integrated health check. Much attention on chronic disease is rightly focussed on either disease prevention for those who are still well or programs for those already sick. However, not enough focus is placed on those who are about to get sick. Well-established, National Health and Medical Research Council (NHMRC) approved-guidelines call for general practitioners (GPs) to conduct assessments for eligible patients to detect those at risk of having a heart attack, stroke or developing type 2 diabetes or chronic kidney disease. Because these diseases often co-exist and share many risk factors, it is recommended that these assessments be done concurrently as part of an Integrated Health Check However, relatively few GPs routinely conduct these checks for eligible patients, therefore missing the opportunity to ensure people at high risk are managed to ensure they stay alive and well, and out of hospital. A new quality-focussed PIP that includes detection and prevention of vascular and related diseases should require general practices to: check eligible patients for vascular and related conditions manage the overall risk profile of patients, stratify risk (high, moderate, low) and address their combined risk factors maintain a patient register, with recall and reminder system record and report the proportion of eligible patients who are checked, have their risk managed, have a GP Management Plan (GPMP) and access evidence-based prevention programs. An MBS item should also be established to support uptake and implementation of the Integrated Health Check. Undertaking Integrated Health Checks and ensuring on-going management of patients at risk should be incorporated into the proposed quality-focused PIP, now being developed by the Federal Health Department. NATIONAL HEART FOUNDATION OF AUSTRALIA 7

8 The benefit-cost ratio of investment in research for cardiovascular disease (including stroke) is 6: Fund 50 cardiovascular disease research fellowships Recommended action: Fund 50 cardiovascular research fellowships. For more than 50 years, the Heart Foundation has played a vital role in the research of the causes, treatment and prevention of cardiovascular disease and its related disorders. Over this time, the Heart Foundation has invested more than $500 million towards cardiovascular research helping to attract the best and brightest medical minds to cardiovascular research.but cardiovascular research now faces a serious crisis. There is a need to break the cycle of decline and restore funding so that the research community can continue to build on the success of the past six decades and keep mortality rates in decline as the population ages and grows. This is critical for the social and economic well-being of the nation, as cardiovascular disease is a leading killer of Australians and the most expensive disease in terms of direct healthcare costs. Investment in cardiovascular research reaps enormous social and economic benefits and drives improvement in quality and outcomes. Australian Government funding for 50 cardiovascular research fellowships will help break the cycle of decline in cardiovascular research and enable heart and stroke research to continue to contribute to keeping our ageing population fit, well and out of hospital. The fellowships should be aimed at attracting mid-career researchers. In order to attract high-calibre candidates, each fellowship should offer $110,000 per annum in salary with an annual project support package of $40,000. This will require an investment of $24 million over three years. The investment in 50 cardiovascular research fellowships will significantly boost the capacity of cardiovascular research in Australia. In addition, funding that will flow from the new Medical Research Future Fund should be allocated to priorities that reflect the burden of disease facing the nation, ensuring that the leading causes of death and disease attract appropriate research funding. SIX ACTIONS TO TACKLE CARDIOVASCULAR DISEASE 8

9 Combining a risk assessment for heart disease and stroke, a type 2 diabetes check and a kidney disease test into an integrated health check is considered best practice as it consolidates the necessary checks a patient can request from their doctor. 4. Help Australians Move more, sit less Recommended action: Develop a comprehensive, funded national physical activity action plan. Australia needs a funded national physical activity action plan to help people move more, sit less. The evidence is compelling. Physical inactivity is a major health problem in its own right. Disturbingly, two in three (66.2%) Australians aged 15 and over are sedentary or have low levels of exercise. 9,10 Physical inactivity: costs the health budget an estimated $1.5 billion a year 11 causes an estimated 14,000 deaths a year 12 was responsible for one-third of the burden of disease in Australia caused by coronary heart disease 6 is a critical factor in Australia s obesity epidemic, with more than half of all Australian adults being overweight or obese. 13 If physical activity is thought of as a medication with an adult dose of minutes a day, there is scarcely anything that could be taken daily that would provide comparable health benefits. 17 And yet, despite strong evidence of the benefits of physical activity, far too many Australians lead sedentary lives. Since 2001, the number doing very little or no exercise has continued to increase. Eight in 10 children do not meet the physical activity guidelines of 60 minutes a day. 14 Older Australians fare little better. Most Australians are either sedentary or undertaking low levels of physical activity. 15 Despite these disturbing statistics, Australia is yet to develop a national physical activity action plan. Many other nations, including the US, New Zealand and Canada, have done so. In fact, an international assessment of 131 countries conducted in 2015 by the Global Observatory for Physical Activity, revealed that 37 nations have national physical activity action plans, and a further 64 had physical activity included as part of their chronic disease plans. The Heart Foundation calls for the development of a national physical activity action plan that supports programs and initiatives in the nine priority areas identified at the national physical activity consensus summit in Canberra in NATIONAL HEART FOUNDATION OF AUSTRALIA 9

10 There is strong support across jurisdictional and non-government stakeholders for the formulation of a national action plan for cardiovascular disease Close the gap on rheumatic heart disease Recommended action: Continue to fund the National Partnership Agreement on rheumatic fever strategy and RHDAustralia at current or greater levels. Rheumatic heart disease (RHD) is primarily a disease of social disadvantage in which the highest burden, sadly, falls on Aboriginal and Torres Strait Islander communities. It is considered a Third World disease that unnecessarily adds to the already high burden of cardiovascular disease for Aboriginal and Torres Strait Islander peoples. Cardiovascular disease is the leading cause of death for Aboriginal and Torres Strait Islander peoples. They are eight times more likely than other Australians to be hospitalised for rheumatic fever and RHD. In the Northern Territory in 2010, the prevalence of RHD among Aboriginal and Torres Strait Islander peoples was as much as 26 times the rate for non-indigenous people. While Australia is one of only three countries that take a national approach to RHD, more needs to be done to close the gap between Aboriginal and Torres Strait Islander peoples and non-indigenous Australians. The Australian Government should build on the work of the National Partnership Agreement on rheumatic fever strategy and strengthen current levels of funding for control programs and RHDAustralia. The employment of low-cost diagnostics such as echo screening will reduce the number of children who are undiagnosed with RHD. Government support for the development of an easilyadministered, long-acting penicillin and vaccine research trials will help accelerate the elimination and prevention of RHD. By committing to addressing rheumatic heart disease, the Government can enhance its ability to reduce the disparity between Aboriginal and Torres Strait Islander peoples and non-indigenous Australians, and eliminate this disease as a public health priority within five years. SIX ACTIONS TO TACKLE CARDIOVASCULAR DISEASE 10

11 More than one-third (34%) of hospital admissions for heart attack are repeat events Fund a national audit of cardiac rehabilitation services Recommended action: Fund an audit of cardiac rehabilitation that will help to identify gaps and opportunities for improvement. People who have had a heart attack or who have heart failure should be referred to, and complete, a cardiac rehabilitation or heart failure program. It is one of the very best things a heart attack survivor can do to reduce the chances of having a further cardiac event. It also enhances the quality of life for heart attack survivors and those suffering from heart failure. Cardiac rehabilitation and heart failure programs are an essential but underused part of recovery from heart attack and/or management of heart failure. It is estimated that attendance rates for cardiac rehabilitation are as low as 11 31%. 18 Cardiac rehabilitation programs guide and support patients to help them recover from heart attack. They encourage lifestyle modification, such as quitting smoking; address psychosocial risk factors, including depression; and improve medication management and compliance. Data from the Australian Institute of Health and Welfare shows 54,000 Australians were admitted to hospital in because they had a heart attack. 6 Each hospital admission for heart attack costs around $27,000 per patient, including more than $17,000 in direct hospital costs. This costs the hospital system in Australia $1.45 billion a year. 19 Unfortunately, referral to cardiac rehabilitation programs does not happen often enough, despite strong evidence showing these programs work. A recent study showed $227 million worth of economic and social benefits could be made from increased cardiac rehabilitation participation in Victoria over a 10 year period. 19 Another Victorian study showed a 35% increase in five-year survival rates among patients who attended cardiac rehabilitation. 20 Other studies have shown better outcomes for physical activity, blood lipid levels, medication adherence, healthcare use, social adjustment, smoking reduction and reduced risk of a cardiac event reoccurring. 21 In the UK, an annual audit of cardiac rehabilitation has helped shine the light on referral and completion rates, and has helped drive improvements across the system. Australia needs a similar annual audit to help save lives and reduce costs. A small investment in the audit has the potential to drive major change. NATIONAL HEART FOUNDATION OF AUSTRALIA 11

12 A comprehensive approach to cardiovascular disease Six actions to tackle cardiovascular disease Develop a national heart and stroke strategy Detect and manage those at risk Fund 50 cardiovascular disease research fellowships Help Australians Move more, sit less Close the gap on rheumatic heart disease Fund a national audit of cardiac rehabilitation services $0.5 million No cost, MBS item $24 million over 3 years $35 million a year $10 million over 3 years $1 million a year Additional measures Increase public health investment Strengthen national food reformulation program Fund national obesity prevention and nutrition strategies Invest in tobacco control, especially education campaigns Review cardiovascular disease risk guidelines Fund the review of vital heart failure guidelines Fund national heart failure study Fund expansion of telemedicine pilot programs for stroke National defibrillator program for sport venues and clubs Reduce the incidence of rheumatic heart disease Reporting of treatment times for heart attack and stroke Monitor stroke quality care and target quality improvement Biomedical component of the National Health Survey Boost investment $5 million a year Scalable Boost investment $1.2 million $2.8 million $5 million $2.2 million over 2 years $6.5 million a year $15 million over 4 years $4 million over 4 years $6.4 million over 4 years $12 million every 6 years SIX ACTIONS TO TACKLE CARDIOVASCULAR DISEASE 12

13 References 1. Australian Bureau of Statistics. Causes of Death, Australia Canberra: ABS, Australian Institute of Health and Welfare. Australia s Health Canberra: AIHW, Australian Bureau of Statistics. Australian Health Survey Canberra: ABS, Australian Institute of Health and Welfare. Cardiovascular disease, diabetes and chronic kidney disease: Australian facts morbidity hospital care. Canberra: AIHW, Australian Bureau of Statistics. Causes of Death, Australia, Canberra: ABS, Australian Institute of Health and Welfare Australian Burden of Disease Study: Impact and causes of illness and death in Australia Australian Burden of Disease Study series no. 3. BOD 4. Canberra: AIHW 7. Department of Health and Ageing. Review of Cardiovascular Disease Programs. Final Report, March Canberra: DHA, Access Economics. Extrapolated returns on investment in NHMRC medical research. Sydney: Deloitte Access Economics, Australian Bureau of Statistics. Australian Health Survey: Physical Activity, Canberra: ABS, Heart Foundation. Sitting still making you ill, new health survey shows, Media release, 19 July, Melbourne: Heart Foundation, Australian Institute of Health and Welfare. The Burden of Disease and Injury in Australia Canberra: AIHW, Medibank Private, Econtech and KPMG. Cost of Physical Inactivity, 2nd Report, Australian Bureau of Statistics. Australian Health Survey Canberra: ABS, Active Healthy Kids Australia. Is sport enough? The 2014 active, healthy kids Australia report card. Adelaide: Active Healthy Kids Australia, Australian Bureau of Statistics. Australian Health Survey Canberra: ABS, National Heart Foundation of Australia. Canberra Communique Australia needs a funded National Physical Activity Action Plan. Melbourne: NHFA, National Heart Foundation of Australia (2016) Federal Budget Submission Jones R, Read K, Keech W. Saving lives with cardiac rehabilitation: why don t people attend? Proceedings of the ACRA 17th Annual Scientific Meeting and Exhibition August 2007; Hobart. 19. De Gruyter E, Ford G, Stavreski B. Economic and social impact of increasing uptake of cardiac rehabilitation services a cost benefit analysis. Heart Lung Circ 2016; 25(2): Sundararajan V, Bunker SJ, Begg S, Marshall R, McBurey H, Attendance rates and outcomes of cardiac rehabilitation in Victoria. MJA 1998;180(6): Australian Institute of Health and Welfare. Heart, stroke and vascular diseases Australian facts Canberra: AIHW, Access Economics. ACS in Perspective: The importance of secondary prevention. Sydney: Deloitte Access Economics, NATIONAL HEART FOUNDATION OF AUSTRALIA 13

14 For heart health information heartfoundation.org.au 2016 National Heart Foundation of Australia ABN The entire contents of this material are subject to copyright protection. Enquiries concerning permissions should be directed to SIX ACTIONS TO TACKLE CARDIOVASCULAR DISEASE HFN